A Closer Look at Rejection Sensitive Dysphoria (RSD) in ADHD (+ how to hack it)

2 January 2025

Rejection Sensitive Dysphoria (RSD) is increasingly recognised in both scientific literature and the neurodiverse community. It describes the intense emotional sensitivity and overwhelming reactions to perceived or actual rejection, criticism, or failure. For individuals with ADHD, these emotional responses tend to be heightened compared to those in neurotypical individuals. But what is RSD, and why is it closely associated with ADHD? Let’s explore.

What is Rejection Sensitive Dysphoria?

RSD refers to the intense emotional response that people with ADHD may experience when they feel rejected, criticised, or judged. These reactions are often disproportionate to the situation, yet they can be swift and overwhelming, affecting mental health, relationships, and overall well-being.

Emotional overreaction

A minor criticism or perceived slight can trigger intense feelings of shame, embarrassment, or sadness – referred to as ‘dysphoria’, which means an unbearable emotional pain.

Fear of rejection

Individuals with RSD often develop a persistent fear of being rejected or judged, leading them to avoid situations where criticism might occur, even if the likelihood is small.

Internalising failure

Even small mistakes can result in deep feelings of inadequacy and self-blame, reinforcing a cycle of negative self-perception.

Physical symptoms

Some people with RSD may also experience physical discomfort, such as headaches or chest pain, alongside their emotional distress.

The Connection Between ADHD and RSD

ADHD has long been associated with emotional dysregulation, and recent studies emphasise that emotional impulsivity is as central to ADHD as attention deficits or hyperactivity. Emotional regulation for individuals with ADHD is not just about controlling emotions, but also about managing the intensity of what they feel. A dysregulated emotions and thinking will often lead to a dysregulation in behaviour.

People with ADHD are more sensitive to social feedback, making them more susceptible to the intense emotions associated with RSD. Dr William Dodson, a specialist in adult ADHD, has noted that up to 99% of adults with ADHD experience some form of emotional dysregulation, with around one-third citing RSD as their most problematic symptom.

RSD vs. Typical Emotional Responses

RSD differs greatly from the typical discomfort one might feel after being rejected. While no one enjoys rejection or criticism, for individuals with RSD, the emotional pain can feel unbearable, almost like a physical blow. This can lead to isolation and a sense of alienation from others. The abrupt and extreme mood shifts caused by RSD are sometimes misdiagnosed as conditions such as bipolar disorder, though RSD episodes tend to be much shorter.

What makes RSD distinct from regular emotional responses is its overwhelming intensity and the speed at which these emotions take hold. Afterward, the person may feel ashamed or frustrated with themselves for overreacting, which in turn leads to a cycle of self-criticism and a desire to hide their vulnerability. The impulsivity of ADHD combined with RSD can create the perfect storm.

Managing RSD often requires a multi-faceted approach that combines therapy, medication, and strong support networks to help individuals regain control over their emotions and break free from the cycle of fear, rejection, and self-doubt.

In a recent podcast by Dr Jo Perkins and Dr Mark Rackley: “The Science of Rejection Sensitive Dysphoria”, we discussed some quick hacks to help manage RSD:

Conclusion

Rejection Sensitive Dysphoria may not yet be a formal clinical diagnosis, but for many people with ADHD, it is a very real and painful experience. As our understanding of ADHD evolves, so does our recognition that emotional regulation plays a key role in the condition. Despite the emotional challenges tied to RSD and ADHD, individuals can still thrive in their personal and professional lives with the right support.

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